Sunday, April 24, 2016

[George Alfred Townsend was only twenty when he began to report the Civil War for the New York Herald, but he quickly established himself as one of the most brilliant of all the many war correspondents. There are few more graphic accounts of wounds, disease and death than those from his gifted pen.]

It was evening, as I hitched my horse to a stake near-by, and pressed Up to the receptacle for the unfortunates. Sentries enclosed the pen, walking to-and-fro with loaded muskets; a throng of officers and soldiers had assembled to gratify their curiosity; and new detachments of captives came in hourly, encircled by sabremen, the Southerners being disarmed and on foot.

The scene within the area was ludicrously moving. It reminded me of the witch-scene in Macbeth, or pictures of brigands or Bohemian gypsies at rendezvous, not less than five hundred men, in motley, ragged costumes, with long hair, and lean, wild, haggard faces, were gathered in groups or in pairs, around some fagot fires. In the growing darkness their expressions were imperfectly visible; but I could see that most of them were weary, and hungry, and all were depressed and ashamed. Some were wrapped in blankets of ragcarpet, and others wore shoes of rough, untanned hide. Others were without either shoes or jackets, and their heads were bound with red handkerchiefs. Some appeared in red shirts; some in stiff beaver hats; some were attired in shreds and patches of cloths and a few wore the soiled garments of citizen gentlemen; but the mass adhered to homespun suits of gray, or "butternut," and the coarse blue kersey common to slaves. In places I caught glimpses of red Zouave breeches and leggings; blue Federal caps, Federal buttons, or Federal blouses; these were the spoils of anterior battles, and had been stripped from the slain. Most of the captives were of the appearances denominated "scraggy" or "knotty." They were brown, brawny, and wiry, and their countenances were intense, fierce, and animal. They came from North Carolina, the poorest and least enterprising Southern State, and ignorance, with its attendant virtues, were the common facial manifestations. Some lay on the bare ground, fast asleep; others chatted nervously as if doubtful of their future treatment; a few were boisterous, and anxious to beg tobacco or coffee from idle Federals; the rest-and they comprehended the, greater number-were silent, sullen, and vindictive. They met curiosity with scorn, and spite with imprecations.

A child-not more than four years of age, I think-sat sleeping in a corner upon an older comrades's lap. A gray-bearded pard was staunching a gash the tail of his coat. A fine-looking young fellow sat with face in his hands, as if his heart were far off, and he wished to shut out this bitter scene. In a corner, lying morosely apart, were a Major, three Captains, and three Lieutenants,-young athletic fellows, dressed in rich gray cassimere, trimmed with black, and wearing soft black hats adorned with black ostrich-feathers. Their spurs were strapped upon elegantly fitting boots, and they looked as far above the needy, seedy privates, as lords above their vassals....

I rode across the fields to the Hogan, Curtis, and Gaines mansions; for sonic of the wounded had meantime been deposited in each of them. All the cow-houses, wagon-sheds, hay-barracks, hen-coops, Negro cabins, and barns were turned into hospitals. The floors were littered with "corn-shucks" and fodder; and the maimcd, gashed, and dying lay confusedly together. A few, slightly wounded, stood at windows, relating incidents of the battle; but at the doors sentries stood with crossed muskets, to keep out idlers and gossips. The mention of my vocation was an "open scsame," and I went unrestrained, into all the largest hospitals. In the first of these an amputation was being performed, and at the door lay a little heap of human fingers, feet, legs, and arms. I shall not soon forget the bare-armed surgeons, with bloody instruments, that leaned over the rigid and insensible figure, while the comrades of the subject looked horrifiedly at the scene.

The grating of the murderous saw drove me into the open air, but in the second hospital which I visited, a wounded man had just expired, and I encountered his body at the threshold. Within, the sickening smell of mortality was almost insupportable, but by degrees I became accustomed to it. The lanterns hanging around the room streamed fitfully upon the red eyes, and half-naked figures. All were looking up, and saying, in pleading monotone: "Is that you, doctor?" Men with their arms in slings went restlessly up and down, smarting with fever. Those who were wounded in the lower extremities, body, or head, lay upon their backs, tossing even in sleep. They listened peevishly to the wind whistling through the chinks of the barn. They followed one with their rolling eyes. They turned away from the lantern, for It seemed to sear them. Soldiers sat by the severely wounded, laving their sores with water. In many wounds the balls still remained, and the discolored flesh was swollen unnaturally. There were some who had been shot in the bowels, and now and then they were frightfully convulsed, breaking into shrieks and shouts. Some of them iterated a single word, as, "doctor," or "help," or "God," or "oh! " commencing with a loud spasmodic cry, and continuing the same word till it died away in cadence. The act of calling seemed to lull the pain. Many were unconscious and lethargic, moving their finger, and lips mechanically, but never more to open their eyes upon the light; they were already going through the valley and the shadow.

I think, still, with a shudder. of the faces of those who were told mercifully that they could not live. The unutterable agony; the plea for somebody on whom to call; the longing eyes that poured out prayers; the looking on mortal as if its resources were infinite; the fearful looking to the immortal as if it were so far off, so implacable, that the dying appeal would be in vain; the open lips, through which one could almost look at the quaking heart below; the ghastliness of brow and tangled hair; the closing pangs; the awful quietus. I thought of Parrhasius, in the poem, as I looked at these things:-

"Gods!
Could I but paint a dying groan-"

And how the keen eye of West would have turned from the reeking cockpit of the Victory, or the tomb of the Dead Man Restored, to this old barn, peopled with horrors. I rambled in and out, learning to look at death, studying the manifestations of pain,-quivering and sickening at times, but plying my avocation, and jotting the names for my column of mortalities....

Ambulances, it may be said, incidentally, are either two-wheeled or four-wheeled. Two-wheeled ambulances are commonly called "hop, step, and jumps." They are so constructed that the forepart is either very high or very low, and may be both at intervals. The wounded occupants may be compelled to ride for hours in these carriages, with their heels elevated above their heads, and may finally be shaken out, or have their bones broken by the terrible jolting. The four-wheeled ambulances are built in shelves, or compartments, but the wounded are in danger of being smothered in them.

It was in one of these latter that I rode, sitting with the driver. We had four horses, but were thrice "swamped" on the road, and had to take out the wounded men once, till we could start the wheels. Two of these men were wounded in the face, one of them having his nose completely severed, and the other having a fragment of his jaw knocked out. A third had received a ball among the thews and muscles behind his knee, and his whole body appeared to be paralyzed. Two were wounded in the shoulders, and the sixth was shot in the breast, and was believed to be injured inwardly, as he spat blood, and suffered almost the pain of death.

The ride with these men, over twenty miles of hilly, woody country, was like one of Dante's excursions into the Shades. In the awful stillness of the dark pines, their screams frightened the hooting owls, and the whirring insects in the leaves and tree-tops quieted their songs. They heard the gurgle of the rills, and called aloud for water to quench their insatiate thirst. One of them sang a shrill, fierce, fiendish ballad, in an interval of relief, but plunged, at a sudden relapse, in prayers and curses. We heard them groaning to themselves, as we sat in front, and one man, it seemed, was quite out of his mind. These were the outward manifestations; but what chords trembled land smarted within, we could only guess. What regrets for good resolves unfulfilled, and remorse for years misspent, made hideous these sore and panting hearts? The moonlight pierced through the thick foliage of the wood, and streamed into our faces, like invitations to a better life. But the crippled and bleeding could not see or feel it,-buried in the shelves of the ambulance.

Townsend, "Campaigns of a Non-Combatant"

Source: "The Blue and The Gray" by Henry Steele Commager. His source was Townsend, Campaigns of a Non-Combatant

This year's theme for the World Health Organization is vector-borne diseases, with a first-time focus on dengue, according to the Division of Vector-Borne Diseases (DVBD) of the Centers for Disease Control and Prevention ( CDC).

Vector-borne diseases are bacterial and viral diseases transmitted by mosquitoes, ticks and fleas. Mosquito-borne diseases such as malaria and yellow fever have plagued parts of this country for decades. Apparently dengue fever, that is making a comeback, also was around during the Civil War.

Union soldiers during the Civil War became sick with mosquito-borne diseases as they traveled into the southern part of the United States. They already had been weakened by dysentery and chronic diarrhea.There was a disease they simply called Chickahominy fever.It might have been malaria, typhoid, typhus or dengue fever (pronounced dengee).

Gen. George McClellan was felled by malaria and attacks of acute neuralgia. Nine other Union generals became seriously ill of disease at one time or another during one campaign to Richmond. "As McClellan's troops approached Richmond in 1862 thousands were felled by disease in swamps along the sluggish Chickahominy River," according to the book "Smithsonian Civil War -- Inside the National Collection."

"Many terrifying diseases (during the Civil War) had colorful encryption names such as 'childbed fever' for puerperal fever, 'breakbone fever' for dengue fever, 'ague' for malaria, 'consumption' or 'the white plague' for tuberculosis, 'the grippe' for influenza and 'Yellow Jack' or 'the American plague' for yellow fever. People simply described all contagious diseases as 'pestilence'," according to "Civil War America, 1850 to 1875" by Richard F. Seicer. ...

Civil War soldiers had several other communicable diseases such as measles and whooping cough. "A single measles epidemic at Camp Moore, training centre in North Louisiana, killed 600 to 700 recruits," wrote John Macdonald in "The Historical Atlas of the Civil War."

There was an epidemic of dengue in July 1850-1851 in southern port sites beginning with Charleston, S.C., preceding the Civil War.

Aedes Aeqypti and Ae. Albopictus are the primary mosquito vectors for yellow fever and dengue fever, according to the CDC. The species is found throughout most tropical to subtropical world regions including many states in the U.S. according to the Department of Entomology at Rutgers University, New Jersey.

During the Spanish-American War, U. S. troops suffered more casualties from yellow fever than enemy fire. In the Cabanatuan prison camp at Manila in the Philippines during World War II everyone had dysentery to some degree. Rice was the daily fare with a few greens and a little fish. Dengue fever plagued many and little could be done for them, according to James F. McIntosh in his book "Wisconsin at War."

Dengue and Dengue Hemorrhagic Fever viruses infect up to 100 million people annually, according to the CDC. Transmission occurs when a female Aedes mosquito bites an infected individual. The mosquito becomes infected and gives the infection to a person it bites. The incubation period for an infected individual can be five days or longer. Dengue fever can progress into dengue hemorrhagic fever.

Dengue hemorrhagic fever (DHF) causes a fever lasting from two to seven days. When the fever declines, this marks the beginning of a 24-28 hour period when the smallest blood vessels (capillaries) become permeable (leaky) allowing the fluid component to escape from the blood vessels into the peritoneum and pleural cavity (leading to pleural effusions)

This may lead to failure of the circulatory system and shock and possibly death without prompt, appropriate treatment, according to the CDC. The patient will bruise easily or have skin hemorrhages, bleeding nose or gums and possibly internal bleeding. There is no specific medication for treatment of a dengue infection. Fluid replacement therapy may help.

For dengue fever a patient should avoid pills containing ibuprofen, Naproxen and aspirin, according to the CDC.

There is very good description of dengue fever in the novel, "The Testament" by John Grisham. The main character, Nate, a lawyer, ends up in the Brazilian jungle looking for a missionary who has inherited a lot of money. He contracts dengue fever.

At first the characters in the book think he has malaria. Nate can barely hear them talking to him. They say it is similar to malaria because Nate has a fever and chills and sore muscles and joints. But a rash on Nate indicated it was dengue. Nate was covered with mosquito bites. His eyes were swollen shut. His fever was high. He became delirious. He was taken to a primitive hospital and given antibiotics and painkillers, and lots of water.

Today we have an enormous problem facing us as 162,000 people from countries other than Mexico have crossed our southern border during a time span from last October to the end of May. Sporadic outbreaks of dengue fever with local transmission have occurred in Florida, Hawaii, and along the Texas-Mexico border.

Because of the seven-day viremia bloodborne transmission is possible. (Viremia occurs when the virus enters the bloodstream and has access to the rest of the body, bloodborne transmission is then possible through exposure to infected blood, organs, other tissues and bone marrow.)

This could be through shared needles, a cut, secretions or inhalation of aerosolized virus. A person might not appear to be sick upon entry to the U.S. and still be able to transmit dengue and other diseases such as the West Nile virus and HIV- diseases for which there is no specific cure.

Garrod was born in Ipswich. He was the son of Robert Garrod, himself the son of a tenant farmer who had founded a successful firm of auctioneers and estate agents. Alfred decided to follow a medical career. He was initially apprenticed to Charles Chambers Hammond at Ipswich Hospital but moved to University College Hospital, where he qualified MB in 1842 and MD in 1843. He was then appointed clinical assistant to the chemical department, where he ‘shall be occupied chiefly in the analysis of morbid fluids and other substances occurring in cases in the hospital and sent to him by the medical officer’. He was then assistant physician to the West London Hospital and also physician at the Aldersgate Dispensary and lecturer at the Aldersgate School 1846–7. In 1848 he made his major contribution to our knowledge of the causation of gout. At a public lecture on 8 February 1848, reported in the Medical Chirurgical Transactions, he demonstrated the increase in uric acid in the blood of patients with gout, whereas there was no such increase in acute rheumatism or Bright's disease. At this time he was assistant physician to University College Hospital. Later, in 1854, he developed the ‘thread test’ and, in 1859, demonstrated smaller quantities of uric acid in the normal serum. He also demonstrated deposits of urate in the articular cartilage of gout.
The importance of his results did not at first receive universal acceptance and it was not until 1960 that Hollander identified uric acid crystals in the synovial fluid in gout. Garrod was appointed full physician to University College Hospital in 1849 and continued lecturing at the hospital, sometimes starting at 8 a.m. in the summer. He played a full part in hospital affairs and organized the establishment of a museum of materia medica. In 1859 he made his other major contribution to rheumatology. It is likely that rheumatoid arthritis had been present as a disease for a long time, certainly since the time of Sydenham, but the nomenclature had been confused with terms like rheumatic gout, chronic rheumatism, rheumalgia, scorbutic rheumatism, etc. And it was not until 1800, when Londré Beauvais described typical cases with pathology, that it became clear that the disease was a separate entity.

Garrod, in his treatise of 1859, discussed the differential diagnosis of these various conditions. He rejected the chronic rheumatism of Heberden and the rheumatic gout of Fuller and chose the name ‘rheumatoid arthritis’ for the disease, and provided illustrations. He divided it into acute, chronic and irregular forms of generalized and localized type. The name has remained ever since.

Garrod attained a leading position in the hospital and was appointed Professor of Materia Medica and Therapeutics and of Medicine. He was elected FRCP in 1856 and elected FRS in 1859. It was therefore surprising that, in 1863, he resigned his appointment at University College Hospital. This seems to have been precipitated by the appointment of Dr William Jenner as Professor of the Principles and Practice of Medicine (on the death of Dr Walshe in 1862), and Garrod was offended at being passed over. It was said that his lectures were too much devoted to chemistry and botany with a lack of therapy and pharmacology.

However, he was appointed Professor of Materia Medica and Therapeutics at King's College Hospital in 1863. The move was not altogether a happy one as it gave rise to a certain amount of heartburn among some junior members of the medical department at the introduction of an outsider to occupy a senior post. He left hospital practice in 1874 and became an honorary fellow of King's College and consultant physician to the hospital. Nevertheless, he continued to collect honours. He was knighted in 1887 and appointed Physician Extraordinary to Queen Victoria in 1890. He was Censor of the Royal College of Physicians 1874–5 and 1887, Vice President in 1888, President of the Medical Society of London in 1860 (Orator in 1858). He was Chairman of the British Pharmacopoeia Committee for many years.

In 1845 he married Elizabeth Ann Colchester, also of Ipswich. There were six children, four boys and two girls. A boy and a girl died young, but the other three boys in this remarkable family all reached eminent positions in their chosen careers. Their home, latterly, was 63 Harley Street, where they lived the social life of an upper middle class family and entertained many personalities of Victorian England. His wife died in 1891, but his daughter, Edith Kate, lived at home and survived him. He died on 28 December 1907 and was buried in the Great Northern Cemetery, Southgate. A memorial service was held at All Souls Church, Langham Place, on 2 January 1908. There is a street in Aix les Bains named after him.

Dr. Mary Harris Thompson (1829–1895) was one of the first women to practice medicine in Chicago, and by some accounts the first female surgeon in the US. She was founder, head physician and surgeon of the Chicago Hospital for Women and Children, founder of the Women's Medical College, the first medical school for women in the Midwest, and Chicago's first nursing school.

Early Years
Mary Harris Thompson was born April 15, 1829 in Fort Ann, New York. She began her studies at a nearby school, then transferred to Fort Edward Institute in Fort Edward, New York, and then to West Poultney Academy in Vermont. While at West Poultney, she was encouraged to "prepare herself in some other institution and return to become instructor in physiology, anatomy and hygiene, a department which was desired should be added to the Poultney school."

Career in Medicine
In 1860, at the age of thirty, Thompson decided to become a physician. She enrolled in classes at the New England Female Medical College in Boston, the first medical school for women. Her studies included a one-year internship with Dr. Elizabeth Blackwell [link] at the New York Infirmary for Women and Children. During this time she spent one year in an internship at the New York Infirmary for Women and Children, which was run by Dr. Elizabeth Blackwell [link].

Upon graduating from the New England Female Medical College, Thompson moved to Chicago, where there was little competition for a woman physician. In July 1863 she began working for the Northwestern Sanitary Commission's Chicago branch under Dr. William G. Dyas and Miranda Dyas, caring for women and children who had lost their husbands and fathers in the Civil War.

Chicago Hospital for Women and Children
Thompson was limited in her ability to care for the overwhelming numbers of women and children seeking medical help. Of the two existing hospitals in Chicago, one would not admit women as patients, and neither allowed women doctors to serve on their staff. Therefore, Dr. Thompson began to work toward establishing her own hospital.

The Chicago Hospital for Women and Children opened in May 1865 at the corner of Rush and Indiana streets with fourteen beds. Dr. Mary Harris Thompson served as its head physician and surgeon, and chief of staff – positions she kept the rest of her life. The Hospital provided medical care to indigent women and children and clinical training to women medical students, which was unavailable elsewhere in Chicago.

The hospital depended upon the aid of wealthy Chicago women who raised funds and managed all administrative duties. Several male doctors served as consulting physicians who aided Thompson in her medical and surgical practice, and provided the Hospital with support because of a widespread prejudice against women physicians. The first facility was small, with fourteen beds and a dispensary (pharmacy).

With the rapid inflow of patients and Thompson's desire to expand women's roles in the medical field, the hospital underwent some changes. During the first five years the hospital treated about two hundred patients and more than five hundred patients visited the dispensary. By July of 1869 the facility was not large enough to handle incoming patients, so the hospital moved to new quarters with sixteen beds and a larger dispensary.

With these new and increased responsibilities, Dr. Thompson wanted additional training. She applied to Rush Medical College but was denied admission. In 1869, she asked for the assistance of Dr. William Byford, the Chair of Obstetrics and Diseases of Women at the Chicago Medical College (renamed Northwestern University Medical School in 1891). Through their efforts the Chicago Medical College faculty allowed three women to enroll in the 1869 autumn session.

However, male students and faculty complained that women in the classroom inhibited discussion of indelicate subjects, and some clinical work and lecture material were omitted entirely. Although they agreed to be observed in teaching situations, some patients also felt uncomfortable in the presence of female students. As a result, the school asked the women to leave at the end of one session, and no more women were admitted there until 1926.

Thompson maintained her position at the hospital, becoming one of the best-known women surgeons in the nation. She specialized in pelvic and abdominal surgery and also sought to improve current surgical instruments by inventing her own. Because of her competence, some males in the field who had doubts about women's capacity to practice medicine changed their views. She used her influence to aid women in pursuing careers as physicians.

Woman's Hospital Medical College
Undeterred, Dr. Byford proposed the establishment of a woman's college to be affiliated with the Chicago Hospital for Women and Children. In October 1870, Drs. Thompson and Byford established the Woman's Hospital Medical College. Byford was elected president of the faculty, which was composed of Dr. Thompson and seven consulting physicians at the Woman's Hospital.

The first student was Julia Cole, one of the three women who had been expelled from Chicago Medical College with Dr. Thompson. Cole passed exams for the first year and part of the second year, including dissection and clinical requirements. She completed her studies and graduated from Woman's Hospital Medical College in 1871. It was noted that there were "17 matriculates, and the session was considered a real success."

Traditionally initial medical education is divided between preclinical and clinical studies. The first two years of medical school - preclinical studies - are a mixture of classroom and lab time. Students take classes in basic sciences, such as anatomy, biochemistry, microbiology, pathology and pharmacology.

In the third and fourth years, medical students do rotations at hospitals and clinics, during which they assist residents in a particular specialty such as surgery, pediatrics, obstetrics and gynecology, internal medicine or psychiatry. Clinical training gives students a breadth of knowledge and helps the student consider potential career paths.

The Woman's Hospital Medical College provided equal educational opportunities and clinical experience working with patients for female medical students in the Chicago area. Graduates of the school, who seldom received positions in male hospitals, became interns, residents and attending physicians in the Hospital.

The Great Chicago Fire of 1871 completely destroyed the buildings of the college, the hospital and the homes of most of the faculty members. Temporary accommodations were set up quickly to deal with the aftermath. Thompson moved her patients to the homes of friends, and she and her staff treated burn victims, male and female, in a private home on Adams street. The College held classes in an Adams Street residence a few blocks from the hospital.

Training School for Nurses
After receiving $25,000 from the Relief Aid Society of Chicago in 1872, a permanent building for the hospital was purchased at Adams and Paulina Streets, and the hospital and dispensary reopened that same year. In 1874, another building on the property became the new Training School for Nurses, allowing Dr. Thompson to realize her dream of training women to became nurses. In the hospital's early years this was not possible because of the facility's limited space.

Women from the Chicago area were allowed to attend lectures at the new nursing school and to spend a certain number of morning hours in the wards daily. Each undergraduate nurse was required to serve in the several departments for two years. The nurses received training in various medical skills, such as securing and cleaning wounds, administering proper medications to patients, and numerous other duties.

The "First Nurses Training School in the Middle West" grew with the hospital, and allowed Dr. Thompson to set her own high standards in medical care. Her school also began training nurses in anesthesiology, which can be attributed to Thompson and her specialized nursing program. The nurses with this new training were sought after by hospitals all over the country.

A building was later purchased for the Woman's Hospital Medical College at 337 South Lincoln Street which provided "two amphitheaters, a well equipped chemical laboratory and a convenient, well lighted dissecting room." Despite of having a faculty consisting "of some of the most eminent professors in the city," by 1876, dissatisfaction had grown among the students of the College.

A committee was organized to investigate the causes and found that students' dissatisfaction resulted from "lack of clinical advantages…; the bad condition in which the dissecting room was kept last winter; … irregular attendance of one of the professors; … [and that the] college building is not proportionate in elegance and ornamentation to the dignity of this great institution."

In 1877, the faculty determined that the College was in an "anemic debilitated condition" due to inadequate facilities, lack of teaching apparatus and material, and insufficient interest and involvement of the faculty." In 1879, the Woman's Hospital Medical College separated from the Hospital and the name was changed to Woman's Medical College of Chicago.

Dr. Byford chaired the committee to reorganize the school. A new building was built, financed mostly by loans from the members of the new faculty. In 1879, the name was changed to the Woman's Medical College of Chicago. Dr. Thompson joined the faculty as clinical professor of gynecology. During this time the school's reputation and enrollment increased substantially. In 1885 a new building was erected for the school.

Northwestern University Woman's Medical College
In 1892, the College was taken over by the Northwestern University and renamed the Northwestern University Woman's Medical College. The faculty believed that the relationship would enhance the school's respectability, ensure its longevity, and secure funding to improve teaching and laboratory facilities.

Notable professors joined the faculty of the Medical College, including Drs. William Heath Byford, Mary Harris Thompson, Marie J. Mergler, Bertha van Hoosen (1863-1952), and others. But Northwestern University failed to invest money in the school. As other medical schools in Chicago began accepting women, the school was abruptly closed in 1902.

The following comment made by one of the school's trustees appeared in a Chicago newspaper, dated January 4, 1902, and illustrates the chauvinistic views of the time. Trustee James H. Raymond said of the abandonment of the college:

It is impossible to make a doctor of a woman. We have run the Women's Medical School at a loss of £5,000 a year. Women cannot grasp the chemical and pharmaceutical laboratory work, the intricacies of surgery, or the minute work of dissecting. Fifteen years ago the graduating class of men and women signed a memorial saying that coeducation was a failure. Then we conducted the college exclusively for women, and it has been worse than a failure.

Dr. Thompson continued to work at the institutions she founded for as long as her health remained viable. By the time of her death, she had gained international recognition both as the first female surgeon in Illinois, and for opening up the healthcare profession to women.

Dr. Mary Harris Thompson established some important firsts for women in her lifetime:

Founder of the first medical college for women in the Midwest
First woman surgeon to perform major surgery in the US
Founder of Chicago's first nursing school
Dr. Mary Harris Thompson suffered a cerebral hemorrhage and died in 1895 at age sixty-six.

Shortly after her death, the board of the Hospital renamed the facility the Mary Thompson Hospital for Women and Children.

Much has been written about the hardships of soldiering during the Civil War. However, what of the soldier when he returned home after the war? How did he reintegrate into society and what was left waiting for him? By the 1880s soldiers began to reminiscence about the war in memoirs and regimental histories. But yet there was still a population in both the North and South that drifted from soldier home to soldier home, from town to town, jail to jail and some (perhaps many) living their last days in insane asylums.

Most returned home, picked up the pieces, and moved on. But some could never find that peace.

The first step was returning home. Hundreds of thousands of soldiers traveled by train, horse and foot. Southern soldiers often had the hardest time getting back to their loved ones. Upon returning home, some soldiers might have found that the life they had left behind was gone.

James S. Dupray served honorably with the 12th Iowa Volunteer Regiment, he returned home to “find neither wife or children to greet me.” But that was not the truly stunning news for his “children [were] scattered one in one place and [one] another” and his “Dear wife in her grave.” The loss was almost more than James could bare, “I had nothing to live for and I wanted to lie down in the grave by her side…” Still for his children he soldiered on, selling all the property he had left (totaling $600) and putting it all into an investment property.” When home, one of the more difficult adjustments involved dealing with those who did not “do their duty” and fight for the Union. Dupray noted how those “loyal men [who] enlisted & gave in defence of their country, leaving the traitors at home to rule matters there.”

Families were often waiting in earnest for the return of love ones only to discover that the boy who left for war returned almost unrecognizable. Polly Razey McColley wrote to her son concerning the return from the war of his brother:

"He could not talk hardly any. I think he was out of his head when he first came home for when we saw him coming we went to meet him and Emily (his twin sister) got to him first and I see he could hardly walk and when I got to him I said Emery are you well and took hold of his hand. He said, yes I was never weller in my life…"

Soldiers who were either unwanted or unwilling to stay at home drifted from place to place. Many found their way West and to the Frontier. There some found peace, bought land, and settled down. However, others, such as a veteran name “Len” found themselves in deep trouble. He was put on trial for murder and it was found that “He is not violent but seems to be almost wholly devoid of his mental faculties.” They were not even sure who he was for sometime:

“Len,” is sixty odd years of age and a veteran of the Civil war, on account of which service he receives a pension. He was unable to tell anything of his relatives, but from papers found among his effects it is evident that he has a nephew, a lawyer and prominent citizen of Reading, Pennsylvania.

At one asylum, James Trainor, a Civil War veteran was reported in 1884 as being “insane suffering from Chronic Mania. This man is insane and [amaisotic]. Is unable to give an account of the date of the war, and yet says he was in the army, but knows not if he was in the Confederate or Federal army, if the war took place 5 or 50 years ago.” It is not know if he had a head injury or was simply ruined from his war experiences.

Yet another story that deserves to be presented in its entirety:

“This Is A Hard Way To Use A Man…”

You can’t help but feel sympathy for Uncle Con when you read through his 136-page Civil War pension file. He really was a poor old guy who was a bit overtaken by life. The file itself is a fascinating combination of dry bureaucratic government correspondence, personal letters dictated by Uncle Con, letters and documents from his sister, nieces and nephews and finally, the documents from his funeral and burial in 1917.

Uncle Con’s letters are primarily to various government officials inquiring about the status of his pension payments while he was institutionalized in a string of Soldier’s Homes and insane asylums between 1902 and 1916. What appears to have happened is that Con’s pension checks were, by law, sent to the institutions he was in to pay for his room and board. However, Uncle Con was convinced that he was being unjustly deprived of his money. To the government’s credit, each of his complaints was followed up and documented to show where his money was going.

His rambling letters show someone who was confused and a little paranoid. But they also show flashes of clarity and awareness and give crucial clues about his background to help fill in some of the large blank spots in his history. In spite of any mental illness, the letters also indicate that his treatment in these various homes consisted — not surprisingly — more of warehousing than care. The Soldier’s Homes may have given state-of-the-art care in their day, but seem to have been prone to the shortfalls common to many institutional care facilities even today.

Though records for insane asylums are often limited if not missing, it appears that a significant number of old veterans ended up being wards of the state in some fashion or another.

If it wasn’t the veteran putting himself in the asylum there are even records I have come across where a wife or family will admit their loved one and sometimes under false pretenses in order to gain access to their pension.

Larry M. Logue’s To Appomattox and Beyond : the Civil War Soldier in War and Peace (Chicago : I.R. Dee, c1996.) devotes several chapters to the Civil War soldier after the war. Here are some of his findings:

In 1879 the U.S. Surgeon General estimated that 45,000 veterans were addicted to morphine.

Newspapers often reported of destitute ex-soldiers and of veteran suicides.

By 1870 at least 3,200 veterans were staying in soldier homes in the North.

We also know that Southern soldiers returned to a defeated and often destitute home. It would be years until individual Southern states initiated pension plans, and the aid given could never match what the Union soldier received. Soldiers who suffered the amputation of a limb in both North and South faced hardships and destitution. luckily for the Northern soldier the soldier home and pension plans kept them afloat.

No other part of the battlefield represented such an odd mixture of hope and terror as the field hospital. The writings of veterans almost universally picture it as a place to be feared and avoided if at all possible. To the men who survived the conflict, hospitals presented a gruesome compendium of the horrors of the war, second only to the sight of torn, bloated, lifeless bodies on the field of battle. Yet the field hospital's staff, medicines, facilities, and surgeons were the only hope desperately wounded men had to save life and limb.

It was predictable that there would be contradictory views of the hospital. Only there could wounded soldiers find relief from their pain, comfort and assistance in their weakened and helpless condition, and life-saving surgery and medical care. At the same time, however, the hospital was a site of agony and misery—the place where men with mangled limbs, bleeding bodies, torn flesh, blinded eyes, and worse, were brought together. It was the spot where overworked doctors hurriedly examined and probed painful wounds; where, all too often, surgeons used their instruments to amputate shattered and infected limbs. Field hospitals were facilities where mortally wounded men were given a few comforts and set aside to die. They were in short a concentration of the vilest aftereffects of battle.

The common perception of Civil War hospitals and surgeons was generally quite negative during the conflict. Time did little to alter that point of view and, in fact, did much to reinforce it. The disorganized and grossly inadequate efforts made by both Union and Confederate medical departments at the start of the war were widely reported in newspapers of the day. However, both sides were able to rapidly improve the standard of care delivered to sick and wounded soldiers alike. This remarkable advance in battlefield medical practices saved many lives before the war was over (Bollet 2002, p. xiii).

Hospital Trains

The Civil War was the first railroad war. Both sides used trains to move troops and supplies to the front and transport sick and wounded men to general hospitals located throughout the North and South. Initially, ordinary boxcars were used to haul patients. These cars had no provisions for the feeding, care, or comfort of wounded soldiers, who endured journeys lasting hours, and sometimes days, without medical attention or basic necessities. The agony and misery such trips entailed was extreme, provoking demands for change.

The industry-poor Confederacy could do little to remedy such problems. The North, with facilities for building locomotives and railway cars, developed hospital trains. Specially designed "ambulance cars" were built, each containing space for thirty hospital litters, suspended three high from stanchions by rubber straps. The litters, complete with mattresses and pillows, swung gently, preventing the pain previously caused by any movement of the trains. Each car had a seating area and a fully stocked pantry. A stove heated the cabin. Kitchen and dining cars accompanied the ambulance cars, as did sleeping cars for doctors and nurses staffing the train. The locomotive and tender were painted bright red, and U.S. Hospital Train was emblazoned in large red letters on every car. These trains provided all the facilities of an efficient and well-regulated hospital. Sick and injured troops were never without food, water, comfort, or medical care while being carried to their destination.

But improvements and innovations seldom made headlines and largely went unnoticed. The horror, fear, and sadness surrounding even an efficiently run and effective field hospital kept most veterans from seeing or understanding the vast change for the better made by dedicated doctors, surgeons, officers, and administrators. Postwar memoirs and regimental histories are full of stories of needless amputations conducted without anesthesia. Also prevalent are tales of incompetent surgeons, indifferent doctors, callous nurses or stretcher-bearers, and half-trained medical students conducting unnecessary surgery on injured soldiers simply to gain experience (Bollet 2002, p. xiii).

Perception vs. Reality

The attitude of many soldiers toward the men who worked in field hospitals, and toward what went on in them, is abundantly clear in an account given by a Union officer wounded during the May 23 to July 9, 1863, siege of Port Hudson, Louisiana:

The surgeons used a large Cotton Press for the butchering room & when I was carried into the building and looked around I could not help comparing the surgeons to fiends…. [A]ll around on the ground lay wounded men; some of them shrieking, some cursing & swearing & some praying; in the middle of the room was some 10 or 12 tables just large enough to lay a man on; these were used as dissecting tables & they were covered with blood; near & around the tables stood the surgeons with blood all over them & by the side of the tables was a heap of feet, legs & arms. (Wiley 1952, p. 148)

The bloody mass of waiting wounded, the tables, the appearance of the surgeons, and the agony of the injured were, of course, very real. But the words this injured soldier used to describe what he saw—"butchering," "fiends," "dissecting"—reveal all too well how he perceived those who were about to save his life. His point of view was hardly unusual. For people unaccustomed to the sight of mass casualties gathered together, or the instruments and operations of surgeons, revulsion and horror were common reactions. Wounds, after all, are horrific to look at; suffering is difficult to hear or see, and the methods used by doctors and surgeons to treat major wounds must, of necessity, sometimes cause pain. The very tools used to repair and heal—probes, saws, scalpels, needles—were enough to make most witnesses shudder, especially if they did not fully understand what was being done or why. Any modern person who has felt ill at ease while staring at medical instruments in a doctor or dentist's office has had a similar, although certainly less intense, experience.

Furthermore, field hospitals posed dangers that were unrecognized at the time. The Civil War was fought just prior to the discovery of bacteria and their role in causing infections, and the development of methods of sterilization used to prevent the transmission of disease from cross-contamination.

One Federal surgeon, looking back on the war from the vantage point of 1918, was amazed at the ignorant practices employed between 1861 and 1865:

We operated in old blood-stained and often pus-stained coats…. We used un-disinfected instruments from un-disinfected plush-lined cases, and still worse, used marine sponges which had been used in prior pus cases and had been only washed in tap water. If a sponge or an instrument fell on the floor it was washed and squeezed in a basin of tap water and used as if it were clean. Our silk to tie blood vessels was un-disinfected…The silk with which we sewed up all woulds was undisinfected. If there was any difficulty threading the needle we moistened it with…bacteria-laden saliva, and rolled it between bacteria-infected fingers. We dressed wounds with clean but undisinfected sheets, shirts, tablecloths, or other old soft linen rescued from the family ragbag. We had no sterilized gauze dressing, no gauze sponges…. We knew nothing about antiseptics and therefore used none. (Wiley 1952, p. 148)

Little wonder then, that wounds frequently became infected even after successful operations. Very often, injured men who survived the trip from the battlefield to the field hospital and underwent life-saving procedures died weeks or months later from the unrecognized bacteria that caused gangrene, tetanus, and other complications.

Nonetheless, field hospitals saved many more lives than they took. Fortunate to be working, for the most part, on healthy young men, inured to hardship by a soldier's life, surgeons and doctors ministered to a population with a better than average likelihood of healing and recovering. If infection could be avoided, and the wound was at all survivable, medical personnel usually managed to save life, if not limb.

Supplies

At the war's outset, the typical surgeon used his own personal instruments, usually brought into service from prewar private practice. He was authorized by the government to purchase and use whatever medicines or supplies he thought appropriate. Hospital stewards in every regiment carried a medical knapsack, which was similar in shape and size to the pack carried by infantrymen and worn in identical fashion. Union hospital steward Charles Johnson recalled that this knapsack contained such emergency supplies as "bandages, adhesive plaster, needles, artery forceps, scalpels, spirits of ammonia, brandy, chloroform and ether" (Commager 1973 [1950], pp. 195–196).

The type and quantity of supplies and medicines at the field hospital was constrained by the necessity of mobility. The number of wagons and ambulances assigned to a hospital was finite, and care had to be taken not to overload vehicles that would be pulled by mules or horses over rough and difficult roads. The standard stock of medicines in a field hospital consisted of "opium, morphine, Dover's powder, quinine, rhubarb, Rochelle salts, castor oil, sugar of lead, tannin, sulphate of copper, sulphate of zinc, camphor, tincture of opium, tincture of iron, tincture opii, camphorate, syrup of squills, simple syrup" and a wide variety of alcohol (Commager 1973 [1950], p. 195). Most medicines were compounded in liquid or powdered form. Few pills were available, so powders were typically mixed with water and drunk by the patient. Precise measurements were not made and surgeons simply apportioned the amount of medicine they thought necessary (Commager 1973 [1950], p. 195).

The resulting lack of uniformity in supplies, instruments, and medicines proved a logistical nightmare. Combined with the widely varying levels of experience and skill found among surgeons and stewards, it also frequently resulted in poor or indifferent care for the sick and wounded. By late 1862, however, changes born of experience and good leadership began to address these concerns.

Among the many vital improvements made by Jonathan Letterman, medical director of the Army of the Potomac from July 1862 to January 1864, was standardization of equipment and medicines for field hospitals. …

Scurvy, now known to be caused by a lack of vitamin C, is one of the world's oldest and most devastating deficiency diseases. Historians have been describing scurvy since ancient times primarily because the disease so often seemed to attack invading armies, sailors on long sea voyages, explorers, and even crusaders. For example, it was scurvy, rather than savage storms or hostile natives, that killed many of the crewmen who sailed with Vasco da Gama (1469-1524) in 1498 and with Ferdinand Magellan (1480-1521) in 1519.

Scurvy begins innocently enough, usually with mild fatigue, bleeding gums, and hemorrhagic bruises on the skin. However, after several months of a diet lacking any vegetables or fruits, worsening physical condition continues, resulting in weakened bones, loose teeth which ultimately fall out, severe joint pain, profuse bleeding from a simple cut, anemia, and eventually death.

Fortunately for later researchers, folk remedies for scurvy occasionally appeared in historical accounts. In 1536, for instance, Jacques Cartier (1491-1557) arrived in Newfoundland deeply concerned about the epidemic of scurvy among his crew members. Friendly Indians advised Cartier to give his men an extract of needles from a local tree (thought be white cedar or spruce). Cartier did so and found that almost all his men showed remarkable improvement. During that same century, several other writers reported similar dramatic cures from (among other foods) cloudberries, oranges, and lemons.

Nevertheless, Scottish naval surgeon, James Lind (1716-1794), is generally credited with being the first to discover the cure for scurvy. Shortly after the long sea voyage of Admiral George Anson (1697-1762), from 1740 to 1744 during which more than a thousand sailors out of a crew of 1,955 died primarily from scurvy, Lind began his own investigations into the disease.

From his readings of historical accounts, Lind realized that scurvy might be due to some dietary lack. In 1747, therefore, the physician began treating stricken sailors with various foods, and soon found that citrus fruits produced the fastest and most effective cures. Although Lind published his Treatise on the Scurvy in 1753, it was not until 1795 that the Admiralty prescribed a daily ration of lime juice for all British sailors (Lind's cure gave British sailors their nickname--"limeys"). Scurvy promptly diminished in the British navy; however, for the most part, the rest of the civilized world continued to ignore Lind's findings and to resist the idea that scurvy might be related to a dietary deficiency. During the American Civil War, then, scurvy was still killing soldiers in both the Union and Confederate armies. Ironically, even as late as 1912 when Robert Scott (1868-1912) explored the South Pole,he and his team succumbed not to the intense cold, but to the lack of fruits and vegetables in their diet.

In 1907, two Norwegian biochemists, Axel Holst (1861-1931) and Alfred Frohlich (1871-1953), proved conclusively that a scurvy-like condition could be produced in the guinea pig (one of the few animals unable to synthesize vitamin C from their intestinal bacteria) by restricting certain foods. Equally important, Holst and Frohlich then cured the lab animals by feeding them cabbage. The scientific community was finally convinced that the lack of a specific nutrient must be causing scurvy, and an intensive search began to find the nutrient. The antiscorbutic (or anti-scurvy) factor was not isolated until 1928, however. In that year, two teams of researchers, one headed by Albert Szent-Györgyi in Hungary, the second by Charles G. King in the United States, extracted an antiscorbutic substance from a variety of fruits. The substance was named vitamin C, or ascorbic acid which, in 1933, was synthesized by two other chemists, Norman Haworth (1883-1950) and Tadeus Reichstein. Soon afterward, vitamin C became the first vitamin to be artificially produced and, once marketed for medical purposes, marked the end of scurvy as a deadly disease. Today, those populations in the United States at high-risk for scurvy include alcoholics, drug abusers, and elderly men who live alone and who may experience extremely poor diets.

In the Civil War era, many of the medications we now take for granted did not exist. There were no antibiotics and hardly any vaccines, as no one knew that germs (microorganisms) caused many diseases. Nevertheless, pharmaceuticals played an important role in Civil War medical care.

In 1861, before the start of the war, there were only six colleges of pharmacy in the United States. The first, the Philadelphia College of Pharmacy, had been founded in 1821. The pharmacy school curriculum included chemistry and medical botany, as many medicines of the time were derived from plants and taken in liquid or pill form. Formal training in pharmacy, however, was relatively rare. There were no licensing or state board exams for pharmacists. Rather than a profession, pharmacy was usually seen as a trade, with most training gained during a two- or three-year apprenticeship. Of the 11,000 pharmacists in the country in 1860, fewer than 5 percent had any formal course work.

The war spurred the expansion and industrialization of the field. In 1860, there were 84 manufacturers of pharmaceuticals in the United States; just 10 years later, there were 300. Philadelphia was an important manufacturing center for all war materials, and medications were no exception. For instance, the firm of John Wyeth & Brother was founded in 1860 by two graduates of the Philadelphia College of Pharmacy. Their drugstore and small research lab grew quickly during the war to become a large wholesale business, selling beef extract and a range of medicines to the army.

Another Philadelphia company, Powers & Weightman, had introduced quinine sulfate (cinchona bark extract) for malaria treatment to the United States in the 1820s. Rosengarten & Sons was also a quinine supplier. Together, the two firms served most of the Union Army’s quinine needs. Civilian firms, though, could not give the army all the medications it required. Two Army Medical Laboratories were begun in 1863, one in New York and one in Philadelphia, to produce dozens of medicines in large quantities. Even though medications were being manufactured on an industrial scale, there was little quality control and regulation was uneven.

Army Quartermasters were originally responsible for drug supplies. Later, however, this work was transferred to the Surgeon General’s office. Medications were distributed through a network of depots and subdepots, with New York and Philadelphia serving as main depots. Volunteer organizations, most notably the United States Sanitary Commission, also aided with distribution of medical supplies. Surgeons carried small amounts of drugs in satchels for use in the field, and special medicine wagons transported larger quantities of supplies. Hospital stewards were administrators as well as pharmacists, overseeing many aspects of hospital operations in addition to compounding and distributing medications.

Some common medications included chloroform and ether used as anesthetics for surgery. Contrary to popular belief, virtually all Civil War surgical operations were performed with the patient rendered unconscious by anesthetics. Post-operation pain was often treated with morphine, a derivative of opium. Morphine was perhaps the most widely used painkiller during the war, despite its addictive qualities. Alcohol, particularly whiskey, was frequently employed as a base for liquid medicines and as a tonic. It was also the main ingredient in many popular over-the-counter patent medicines. A nearly universal but perilous drug was calomel, a mercury-based compound, used for constipation as well as diarrhea and dysentery. Since mercury is poisonous, calomel was dangerous in large quantities. Union Surgeon General Dr. William A. Hammond banned its use in 1863, causing much controversy among army physicians.

Information for this section was contributed by The College of Physicians of Philadelphia, in particular Jane E. Boyd, Ph.D., Wood Institute Research Associate, and Robert D. Hicks, Ph.D., Measey Chair for the History of Medicine and Director of the Mütter Museum & Historical Medical Library. For more information about The College of Physicians and the Mütter Museum, visit www.collphyphil.org.

John W. Schildt in his biography of Hunter McGuire summed up the doctor as such: "When people needed to talk, he listened. Those who knew him said Dr. Hunter McGuire made you feel that you were the most important person in the world." Another quote that describes the Winchester physician is "Make not patients of your friends -but friends of your patients."

Such a man was Hunter Holmes McGuire, a native of Winchester, Virginia in the Northern end of the Shenandoah Valley. Born on October 11, 1835, at age 22 he was already a professor and full doctor. An impressive man, tall -- almost 6'4" -- thin, and handsome with black hair and blue eyes, Dr. McGuire was a believer in State's Rights and Virginia and thus embarked on a career as a Confederate Medical Officer in 1861.

At first, he signed up to fight as a private in the Winchester Rifles (Co. F of the 2nd Virginia which fought in the Stonewall Brigade), but McGuire was too valuable to serve as a foot soldier when the Confederacy needed trained doctors. McGuire served under many different commanders; among them were Thomas J. "Stonewall" Jackson, Richard Ewell, and Jubal Early. It is, however, as Jackson's surgeon that Dr. McGuire is remembered. McGuire would later say: "The noblest heritage I shall hand down to my children is the fact that Stonewall Jackson condescended to hold me and treat me as his friend."

McGuire served in all the major battles of the Army of Northern Virginia as the medical director of the famed Second Corps. In May of 1863, Jackson was wounded in the arm by friendly fire at the battle of Chancellorsville. After a week long battle with pneumonia, Jackson died of the pneumonia. (note: modern physicians think Jackson probably died of a pulmonary embolism, not pneumonia as McGuire thought) A picture of McGuire taken in mid-May shows him looking gaunt and exhausted, both indicative of the tireless efforts he put forth in an attempt to save his friend and patient. In fact, Dr. McGuire attempted to give his patient and friend round the clock care.

McGuire saw many tragedies in his career as a medical officer for the dying Confederacy. His good friend and commander Jackson died. His tent-mate Sandie Pendelton was mortally wounded in the Valley in 1864. McGuire's own brother Hugh was mortally wounded in 1865. His beloved home the Shenandoah Valley was in flames. And McGuire himself was captured at Waynesboro on March 2nd. Paroled by General Sheridan for his policy of not keeping Union Surgeons, McGuire was with the Army of Northern Virginia and tasted the bitter defeat of surrender at Appomattox Court House.

McGuire after the War went to Richmond where he built a hospital of his own and had a career that was varied and productive, and often included helping one who had worn the gray during the Civil War. Especially at first, but later as well, he would work without pay. He forever remained a staunch supporter of Jackson's reputation and image, writing several biographical sketches and giving speeches about his former commander. McGuire served also as a professor after the War, was president of numerous medical organizations and societies including the American Medical Association. In addition, he married and fathered 10 children, some of whom followed in his footsteps in pursuing medical careers. He died of complications of a cerebral embolism on September 19, 1900. He is buried amongst many Confederate notables in Richmond's Hollywood Cemetery. A statue stands on the Virginia State House grounds to the Winchester physician.

Hunter McGuire was a truly gifted individual. He was a deft surgeon, a highly gifted and competent doctor, a superb teacher, an outstanding orator, a brilliant administrator, and a prolific writer and author. One person remembered the physician in consulting with his patients was "like a husband pondering the problems of the sick wife; the father looking down on the afflicted child." His contributions to Virginia, the Confederacy, the United States, and medicine as a whole can not be overlooked.

For more information read: "Doctor in Gray" by John Schildt, "Hunter McGuire: Stonewall's Surgeon" by Maurice Shaw, or "Stonewall Jackson" by James Robertson.

Tribute to Dr. McGuire that appeared in the Sept. 19, 1900 Richmond News:

"None more striking has been known to this generation of Virginians. Few men have seen in these parts whose opinions, professional or other, carried as much weight. It may be doubted whether anybody has lived in Virginia since Lee and Jackson died who was loved by more people.
In character, he was all that men mean by "strong", "decided", "vigorous" or any similar term. Nevertheless, he was strikingly simple, straight-forward and unaffected, modest, even to reserve; yet throughout his life, a warrior waging sternest battle for reality and truth, of whom a friend could get real help when counsel was needed, because he had not the coward's gift for tempering opinions to suit the changing expression of his auditor's eye. A brave and true man, in whose sincerity and strength great Jackson could entirely confide; whose force General Lee upon occasion markedly acknowledged."

Inscription on Hunter McGuire's Monument in Richmond:

"Hunter Holmes McGuire, M.D., L.L.D. President of the American Medical and of the American Surgical Associations; Founder of the University College of Medicine Medical Director, Jackson's Corps, Army of Northern Virginia. An Eminent Civil and Military Surgeon and Beloved Physician. An Able Teacher and Vigorous Writer; A Useful Citizen and Broad Humanitarian, Gifted in Mind and Generous in Heart, This Monument is Erected by his Many Friends."

USCivilWar.Net wants to thank Jenny Goellnitz for compiling this information.

"The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well. It is easy to magnify an existing evil until it is beyond the bounds of truth. It is equally easy to pass by the good that has been done on the other side. Some medical officers lost their lives in their devotion to duty in the battle of Antietam, and others sickened from excessive labor which they conscientiously and skillfully performed. If any objection could be urged against the surgery of those fields, it would be the efforts on the part of surgeons to practice "conservative surgery" to too great an extent."
---Dr. Jonathan Letterman

Obiviously, even at the time of the Civil War, the surgeon was coming under attack for his actions.

The Civil War surgeon worked in conditions that today would be completely unthinkable. Doors were often used as operating tables. There was a lack of water, basic supplies, drugs, and most of all: time. Take as an example the best-known battle of the Civil War, Gettysburg. There were approximatly 50,000 casualties at Gettysburg in three days of savage fighting. All of this descended down on the heads of the medical men. For the most part, they measured up admirably. Many of them worked until they dropped. With a lack of time, knowledge, and basic supplies, the best bet for saving life was usually an amputation as soon as possible. Thus, Letterman said if any complaint could be lodged against his surgeons after Antietam, it was that they had been too conservative in cutting off limbs.

The Civil War doctor was not a quack, he does not deserve to be labeled a "butcher" or a "barber" or some other equally derisive term. The Civil War surgeon was the most part a hard working, competent, and compassionate individual. Though obiviously hardened by the sights, sounds, and smells of War, they still did what they thought best. Really, given the medical knowledge of the time and the hideous destructive powers of the Minie ball, they had no chance but to amputate in most cases.

While modern operating rooms are steralized and clean, with efficent lighting, gloves, many complicated and specialized insturments, the Civil War surgeon had little to work with. Lighting, even for general officers, was often a held lantern. Farms, school houses, homes, churches were the operating rooms. The operating table could be a door, sometimes a kitchen table. At the basics, the Civil War surgeon's kit consisted of two surgical saws, a curved probe, retractor, cutting pliers, clamps, brush, and trepanning instruments carried in a plush lined wooden chest.

The Civil War surgeon could often be wounded or even killed. Hospitals sites were chosen close to the line and where water was availible. Improvisation, particularly for the Confederate surgeon, was the name of the game. Hunter McGuire on the adaptability of the Confederate surgeon:

The pliant bark of a tree made for him a good tourniquet; the juice of the green persimmon, a styptic; a knitting needle, with its point sharply bent a tenaculum; and a pen knife, in his hand, a scalpel and bistoury. I have seen him break off one prong of a common table fork, bend the point of the other prong and with it elevate the bone in a depressed fracture of the skull and save life
The Civil War came at the end of the medical middle ages. Little was known of bacteriology for example. Surgery was septic. Yet, to label the Civil War surgeon in derisive terms does him a great injustice. Forty Union doctors lost their lives in battle. Dr. J.B. Fontaine, of the cavalry corps of the ANV, was killed in the line of treating a wounded soldier, Dr. E.S. Galliard had to have his arm amputated after being wounded treating Joe Johnston. Many medical officers, including Jonathan Letterman, died young. The Civil War surgeon often sacrificed his health to do what he could to save life.

USCivilWar.Net wants to thank Jenny Goellnitz for compiling this information.

A large proportion of disabled veterans in both the North and the South did not wear artificial limbs. Many did not even apply for the money they were eligible to collect because of negative attitudes to the idea of charity. Moreover, pinning up an empty sleeve or trouser leg, instead of hiding the injury with a prosthesis, made their sacrifice visible. Displaying an “honorable scar” in this way, especially during and immediately after the war, helped amputees to assert their contribution to the cause.

Veterans who had lost an arm learned to use their remaining limb instead, and could utilize specially-designed devices to tackle everyday tasks. Such strategies were especially important because many prosthetic designs had only limited function and could also be uncomfortable, particularly if the wounds from injury or surgery had healed badly. Moreover, an artificial limb might prove too expensive to repair or replace over the course of a lifetime.

Image 1: Burritt Stiles, 1860s

Image 2: Advertisement promoting exhibition of left-handed penmanship by Civil War veterans who had lost limbs, 1860s

Named from Doctor Thomas Dover, an English physician of the eighteenth century who first prepared it, the powder was an old preparation of powder of ipecacuanha (which was formerly used to produce syrup of ipecac), opium in powder, and potassium sulfate. The powder was largely used in domestic practice to induce sweating, to defeat the advance of a "cold" and at the beginning of any attack of fever. It was also known by the name pulvis ipecacuanhae et opii.

To obtain the greatest benefits from its use as a sudorific, it was recommended that copious drafts of some warm and harmless drink be ingested after the use of the powder.

The following excerpt from a report penned by a Doctor Sharp, employed in the British naval service in the West Indies, in this case, in Trinidad, in 1818, illustrates its use. He writes :

"At this period, thirty cases of acute dysentery also occurred amongst them and although nineteen of the number were men who arrived in the island from Europe on the 1st and 12th of June, yet, the symptoms even in them were equally as mild as in the assimilated soldier, and the disease yielded to the common remedies – viz – bleeding when the state of the vascular system appeared to indicate the use of it, but in general, saline purgatives in small and repeated quantities were only necessary with small doses at bed time, of calomel and opium, infusion of ipecacuanha or Dover’s powder, and this with tonics, moderate use of port wine and a light farinaceous diet generally and speedily accomplished a perfect case."

The South had no organization comparable to the Sanitary Commission, but a Women's Relief Society dedicated itself to collecting money to help sick and wounded soldiers, and thousands of Southern women volunteered for, nursing duty. Mrs. Arthur Hopkins for example not only contributed some $200,000 to hospital work but went to the front and was wounded at Seven Pines; others, like Mrs. Ella Newsom and Miss Kate Cumming, worked indefatigably in the makeshift hospitals of the Confederacy; Mrs. Phoebe Yates Pember-superintendent of a division of the vast Chimborazo Hospital in Richmond-was tireless in hospital and nursing home and even at the front.

Mrs. Blackford was a member of one of Virginia's first families, wife to the distinguished Charles Blackford, judge advocate under Longstreet.

May 7, 1864. The wounded soldiers commenced arriving on Saturday, and just as soon as I heard of it, which was before breakfast, I went to see Mrs. Spence to know what I could do for them. She said the ladies had been so shamefully treated by the surgeons that she was afraid to take any move in the matter. I told her I would go and see Dr. Randolph and ask him if we could not do something. I went down and did so at once and asked him what we could do. He said we might do anything we pleased in the way of attention to them; send or carry anything to them we wished and he would be glad of our help. As soon as I reported to Mrs. Spence what he said she started messengers in every direction to let it be known and I went to eleven places myself. We then determined to divide our provisions into two divisions: the bread, meat, and coffee to be sent to the depot, the delicacies to the hospitals. The reception of wounded soldiers here has been most hospitable. You would not believe there were so many provisions in town as have been sent to them.

On Saturday evening I went up to Burton's factory, where most of the wounded were taken, and found the committee of ladies who had been selected, of whom I was one, just going in with the supper. I went in with them. We had bountiful supplies of soup, buttermilk, tea, coffee, and loaf bread, biscuits, crackers, and wafers. It did my heart good to see how the poor men enjoyed such things. I went around and talked to them all. One man had his arm taken off just below the elbow and he was also wounded through the body, and his drawers were saturated with blood. I fixed his pillow comfortably and stroked his poor swelled and burning arm. Another I found with his hand wounded and his nose bleeding. I poured water over his face and neck, and after the blood ceased to flow wiped his pale face and wounded hand which was black from blood and powder. They were very grateful and urged us to come and see them again.

On Sunday evening news came that six hundred more would arrive and Mrs. Spence sent me word to try and do something. The servants were away and I went into the kitchen and made four quarts of flour into biscuits and two gallons of coffee, and Mrs. Spence gave me as much more barley, so I made, by mixing them, a great deal of coffee. I am very tired.

May 12th. My writing desk has been open all day, yet I have just found time to write to you. Mrs. Spence came after me just as I was about to begin this morning and said she had just heard that the Taliaferro's factory was full of soldiers in a deplorable condition. I went down there with a bucket of rice milk, a basin, towel, soap, etc. to see what I could do. I found the house filled with wounded men and not one thing provided for them. They were lying about the floor on a little straw. Some had been there since Tuesday . and had not seen a surgeon. I washed and dressed the wounds of about fifty and poured water over the wounds of many more. The town is crowded with the poor creatures, and there is really no preparations for such a number. If it had not been for the ladies many of them would have starved to death. The poor creatures are very grateful, and it is a great pleasure to us to help them in any way. I have been hard at work ever since the wounded commenced coming. I went to the depot twice to see what I could do. I have had the cutting and distribution of twelve hundred yards of cotton cloth for bandages, and sent over three bushels of rolls of bandages, and as many more yesterday. I have never worked so hard in all my life and I would rather do that than anything else in the world. I hope no more wounded are sent here as I really do not think they could be sheltered. The doctors, of course, are doing much, and some are doing their full duty, but the majority are not. They have free access to the hospital stores and deem their own health demands that they drink up most the brandy and whiskey in stock, and, being fired up most the time, display a cruel and brutal indifference to the needs of the suffering which is a disgrace to their profession and to humanity.

Chimborazo Hospital in Richmond, Virginia essentially functioned as a village, complete with bathhouse, soap factory, morgues, and a bakery. Phoebe Yates Pember was one of the first women to serve as a hospital matron during the Civil War. Her memoirs describe in vivid detail her experiences as one of the first women to enter the previously all-male field of medicine in the Confederacy.

A Hospital on a Hill
Several million men went off to war in the early 1860s. They fell sick with disease and died from battle wounds by the hundreds of thousands. The Confederate government was not prepared for the sudden burden of caring for so many men. Hundreds of hospitals sprang up in the Confederate States, particularly in Richmond, where five railroads converged and close to many of the war's battles.

On May 29, 1861, Confederate President Jefferson Davis arrived in Richmond. In June 1861, street cleaners and unemployed free blacks were put to work building the three lines of defense around Richmond. The interior line consisted of a series of forts; in the middle line, earthworks were constructed in a five-mile radius from the capitol building, with intermittent installations of artillery batteries; the outer line was a set of simple trenches that soldiers could quickly occupy if the city were threatened.

Essentially, there were three types of fortification surrounding the city – artillery batteries strategically placed to maximize the effectiveness against approaching troops, forts to house more artillery along with soldiers and supplies, and. They were made almost entirely of earth and wood, which is why you often see old photos of fortifications almost completely barren of any nearby trees.

During the summer of 1861, newly-enlisted Confederate troops inundated Richmond. The undeveloped forty-acre plateau in the city's east end, known as Chimborazo Hill, was selected as a camp for soldiers. In late September and early October 1861, a workforce of slaves began erecting permanent winter quarters on the site. Plans called for soldiers' barracks, officers' quarters, three hospitals, and a large bake house.

The newly appointed Surgeon General of the Confederacy, Samuel Moore, soon recognized that Richmond's ability to care for the army's sick and wounded was sorely lacking. Many soldiers had died that previous summer because of the crowded conditions in the hotels, warehouses, stores, and private homes that had been used as makeshift hospitals. With many structures already in place on Chimborazo Hill, Moore decided to use the barracks as the beginnings of a hospital. He placed prominent Richmond physician, Dr. James B. McCaw, in command with the rank of surgeon-in-chief.

The nearly complete winter quarters - which measured about eighty feet by twenty-eight feet - were converted into patient wards. The walls were composed of two-inch-thick boards nailed to a simple vertical frame, and then a coat of whitewash inside and out. The workers covered the roofs with shingles and the floors with wood planks. Three doors and ten windows ran along each side for access and ventilation. There was a woodstove to fend off the cold, and a candle to show the way for the night shift of physicians.

Construction began in the autumn of 1861, and the complex grew to include ninety hospital wards, which were divided into five hospitals that could accomodate 3,600 patients at one time. In addition to the patient wards, Dr. McCaw's crew built kitchens, five ice houses, a large stable, a guard house, a chapel, five mortuaries, and various shops, bringing the total number of buildings to nearly 150. Wide avenues separated the rows of buildings to provide fresh air, which Dr. McCaw believed necessary for a speedy recovery.

With the buildings arranged in this fashion, Chimborazo became the first pavilion-style hospital in America. An assistant surgeon described the scene:

"The hospitals presented the appearance of a large town, imposing and attractive, with its alignment of buildings kept whitened with lime, streets and alleys clean … The buildings were separated from each other by wide alleys or streets, ample spaces for drives or walks, and a wide street around the entire camp or hospital."

Slaves at Chimborazo
In addition to the workforce of slaves who constructed the hospital buildings, Chimborazo relied on the slaves of local plantation owners to fill positions such as cooks and laundresses. Hundreds of African Americans, mostly enslaved males, served as nurses at Chimborazo Hospital. Slaves working at Chimborazo moved from a private to a public work environment and worked alongside free blacks, which must have been somewhat liberating.

Dr. James McCaw recognized early on the necessity of employing blacks for the hospital's own survival:

"I have at this time only two hundred and fifty-six cooks and nurses [slaves] in my Hospitals, to take care of nearly 4,000 sick soldiers ... it will be entirely impossible to continue the hospital without them."

Patient Care
Dr. McCaw first had to organize the massive facility. Contract surgeons were hired as needed, and civilian doctors occasionally volunteered their services. McCaw purchased hospital rations from local suppliers, and for the good of his patients, he established a large vegetable garden and a herd of hundreds of goats and milk cows a nearby farm.

In the summer of 1862, the constant dread that must have niggled at the mind of every person employed there came to pass. Wounded from the Seven Days' Battles filled the hospital beyond capacity. To accommodate the overflow, hospital workers set up Sibley tents, which housed eight to ten soldiers per tent, and the hospital continued to function as before.

The level of medical care within Chimborazo Hosptial varied greatly. Many accounts praised the doctors and the care provided by the female matrons. However, some patients complained that sufficient food was sometimes unavailable and some wards were poorly supervised. Some eyewitnesses went so far as to pronounce the medical staff negligent and the environment filthy and foul-smelling. However, the system worked. Throughout its existence, Chimborazo had a mortality rate of about nine percent; the best-staffed Union hospitals achieved only ten percent.

The Matron Law
On September 27, 1862, Confederate President Davis signed into law "an act to better provide for the sick and wounded of the Army in hospitals." The law provided that each hospital could employ two chief matrons at salaries not to exceed forty dollars per month to "exercise a superintendence over the entire domestic economy of the hospital." Each facility could hire two assistant matrons "to superintend the laundry, to take charge of the clothing of the sick, [and] the bedding of the hospital, to see that they are kept clean and neat." These women received compensation up to thirty-five dollars per month. Each ward could employ two ward matrons for salaries of thirty dollars per month whose duties were:

"to prepare the beds and bedding of their respective wards, to see that they are kept clean and in order, that the food or diet for the sick was carefully prepared and furnished to them, the medicine administered, and that all patients requiring careful nursing are attended to."

For the rest of the war, white Southern women managed Confederate hospitals as matrons. Those who filled these positions had to be blessed with the stamina to endure physical and mental hardships and the will to defy conventional ideas about their proper role in southern society. In addition to their salaries, all matrons received rations and suitable lodging. Matrons were not nurses. Most Civil War nurses in Confederate hospitals were hired slaves, free blacks, or convalescent soldiers. Matrons were almost always white women.

Phoebe Yates Pember
In her book Mothers of Invention: Women of the Slaveholding South in the American Civil War, Drew Gilpin Faust states that only a few "exceptional women" dedicated their lives to work as hospital matrons. Phoebe Yates Pember was one of the first women to serve as a hospital matron, and she served in that position at the largest military hospital in the world: Chimborazo. Pember's memoirs describe the difficulties she encountered as one of the first women to enter the all-male field of medicine.

Pember was born into a prosperous and socially prominent Jewish family in Charleston, South Carolina who later moved to Georgia. When her husband of five years died of tuberculosis in Boston on July 9, 1861, Pember joined her family, who had left the coastal city of Savannah for the supposedly safer town of Marietta, Georgia; they would spend the rest of the war as refugees.

In late 1862, Pember received a letter from her friend Mary Elizabeth Adams Pope Randolph, wife of the Confederate secretary of war. Randolph was active in the Richmond Ladies Association, which organized relief efforts for Confederate soldiers. Randolph offered Pember a position as chief matron of Chimborazo Hospital's Second Division, one of five hospital divisions. It was "rather a startling proposition to a woman used to all the comforts of luxurious life," Pember later wrote in her memoirs, but she reported for duty at the age of 39.

While working at the hospital, Pember not only dealt with the pain and suffering of her patients, but also with shortages of medicine, food and equipment. In addition, she dealt with doctors as well as a society that criticized women for working in hospitals, to which she responded:

In the midst of suffering and death, hoping with those almost beyond hope in this world; praying by the bedside of the lonely and heart stricken; closing the eyes of the boys hardly old enough to realize man's sorrows, much less suffer man's fierce hate, a woman must soar beyond the conventional modesty considered correct under different circumstances.

Pember made sure that the orders of surgeons were performed properly, and that the medical and dietary needs of her patients were fulfilled. As the war progressed, casualties multiplied and Phoebe's duties increased. She continually washed and dressed minor wounds and prepared the most difficult cases for the surgeons. She eventually found some respite from her duties by renting a room in town, to which she returned every night.

By the end of the Civil War, 76,000 patients had received medical care at Chimborazo; 15,000 of those were under Phoebe Pember's supervision in the 150 wards she managed. She remained at Chimborazo until the facility was taken over by Federal authorities and her last patients were discharged. At the end of the war, she wrote, "I found myself with a box full of Confederate money and a silver ten-cent piece." She spent the 10 cents on a box of matches and five coconut cakes.

Phoebe Pember then returned to Savannah, where she maintained her elite social status, and traveled in the United States and Europe. In 1879, her memoirs A Southern Woman's Story: Life in Confederate Richmond was published. It is considered a pioneering resource in women's history. During her last years she lived with her niece, Fanny Phillips Hill in Pittsburgh, Pennsylvania, where she died on March 4, 1913 of breast cancer.

Fall of Richmond
Because Richmond never endured a direct attack, Chimborazo operated safely throughout the Civil War. However, on April 2, 1865, Union forces penetrated Confederate defensive lines around Petersburg, twenty-three miles south of Richmond. When General Robert E. Lee's Army of Northern Virginia retreated to the west, Richmond was no longer protected and had to be evacuated. Those of Chimborazo's patients who were able began leaving on their own, while the staff and those too sick or injured to travel waited for the arrival of Union troops. Dr. McCaw surrendered the hospital to a group of Union surgeons on April 3, 1865. Soon after, ambulances began delivering Union patients, who were placed in separate wards away from the Confederates.

Freedmen's Bureau School at Chimborazo
By the early summer of 1865, patients had been removed from a section of the hospital, which was then designated as classrooms for a Freedmen's Bureau school. Two months after the fall of Richmond, the village on Chimborazo Hill was providing a home as well as an education for thousands of former slaves. Quaker societies like the New York Friends' Association supported the school, and they sent white Quaker women from the northeast to serve as teachers. Almost 200 newly-freed slaves enrolled in an afternoon session, and by fall their number had increased to 345.

The Freedmen's Bureau was a federal agency established to assist freed slaves in finding education and employment. They also used the former barracks and other buildings to house the flood of African American refugees pouring into Richmond. One ward was inhabited by 1,500 ex-slaves, some of whom were employed by Union authorities to begin cleaning up the city.

Sometime after 1869, the Freedmen's Bureau school at Chimborazo closed its doors, probably due to the ratification of the new Virginia Constitution, which required a public school system for all Virginia children. According to the Richmond Public Schools, in 1869, rooms were rented nearby to educate African American children. In 1881, a new school building was constructed, which eventually became today’s George Mason Elementary School.

The buildings at Chimborazo disappeared quickly after that. Local residents, desperate for firewood, tore down the hospital wards and burned them in their fireplaces and stoves.

In 1874, when the city purchased Chimborazo Hill to be used as a park, few buildings remained. In 1909, a United States Weather Bureau Station was constructed on the site. In 1959 the National Park Service acquired six acres of Chimborazo Hill, including the weather station building, which now serves as a visitor center for Richmond National Battlefield Park and the Chimborazo Medical Museum. The museum offers a great deal of information about the famous hospital, other hospitals in Civil War Richmond, and the practice of medicine in the 1860s.

Image 1: Image: Chimborazo Hospital in Richmond, Virginia. A man with a crutch looks out upon the long white buildings of Chimborazo Hospital on the hill above in a photograph taken just after the city had fallen to Union forces in April 1865.